Received: 27th January 2023, Revised: 19th March 2023, 16th April 2023, Accepted: 21st April 2023


  • Rattiya Santisathaporn Registered Nurse, Senior Professional Level, Operation Theater, Loei Hospital, Thailand
  • Thanuset Chokpiriyawat Ph.D. Student, Faculty of Business Administration and Accountancy, Khonkaen University, Thailand



Nursing Care Model, Total Knee Replacement Surgery, Operation Room, Patient, Guidelines, Surgery, Nurse


This research aims to develop a nursing care model for patients undergoing total knee replacement surgery (TKR) using the models Kemmis and McTaggart (1988) as development guidelines. The study has started from April to July 2020 in Operation Department, Loei hospital, Thailand. The purposive sampling method has been selected with participant nurses (n=50). The mixed method design has been used to obtain the new development nursing care model and guidelines for patient care, proper assignment system, and follow-up techniques. The result showed the nurse behavior changed before to after implementing a model in pre-operation, intra-operating, and post-operation stages statistically different at p less than .001 (mean = 4.9 ± 0.1, p<0.001, mean = 1.9 ± 0.1, p<0.001, mean = 2.0 ± 0.0, p<0.001) respectively. The nurse’s satisfaction level after cycle 2 was significantly higher than cycle 1 (mean = 4.2 ± 0.3, p<0.001). The development of the new nursing care model in TKR surgery could lead to changes in the system with gained positive feedback from OR nurses. The nursing leadership, group motivation, and a cooperative nursing team contributed to the successful operation of the new model. This research recommended following this model’s protocols as a routine and further expanding to other departments such as outpatient, inpatient, and continuous care units.


Alexander, V., Ellis, H., & Barrett, B. (2016). Medical–Surgical Nurses’ Perceptions of Psychiatric Patients: A Review of the Literature with Clinical and Practice Applications. Archives of Psychiatric Nursing, 30 (2), 262–270.

Chotanaphuti, T., Kawinwonggowit, V., Leelasestaporn, C., & Rojviroj, S. (2018). A Real-World Management of Osteoarthritis (Oa) Knee Patients Who Undergo Total Knee Replacement – A Retrospective Study in Thailand. (Armor Study). Journal of Southeast Asian Medical Research, 2 (1), 45–57.

Creswell, J. W. (2013). Qualitative Inquiry & Research Design: Choosing among Five Approaches (3rd ed.). Thousand Oaks. CA: SAGE.

DeSanto-Madeya, S. (2007). Using Case Studies Based on a Nursing Conceptual Model to Teach Medical-Surgical Nursing. Nursing Science Quarterly, 20 (4), 324–329.

Edmonds, B., Grimm, V., Meyer, R., Montañola, C., Ormerod, P., Root, H., & Squazzoni, F. (2019). Different Modelling Purposes. Journal of Artificial Societies and Social Simulation, 22 (3), 6.

Fetters, M. D., Curry, L. A., & Creswell, J. W. (2013). Achieving Integration in Mixed Methods Designs-Principles and Practices. Health Services Research, 48 (6pt2), 2134–2156.

Hall, L. M., Doran, D., & Pink, G. H. (2004). Nurse Staffing Models, Nursing Hours, and Patient Safety Outcomes: JONA: The Journal of Nursing Administration, 34 (1), 41–45.

Havaei, F., MacPhee, M., & Dahinten, S. (2019). The effect of nursing care delivery models on quality and safety outcomes of care: A cross-sectional survey study of medical-surgical nurses. Journal of Advanced Nursing, 75 (10), 2144–2155.

Hu, Y., Chen, X., Wang, S., Jing, Y., & Su, J. (2021). Subchondral bone microenvironment in osteoarthritis and pain. Bone Research, 9 (1), 20.

Jakobsson, U., & Hallberg, I. R. (2002). Pain and quality of life among older people with rheumatoid arthritis and/or osteoarthritis: A literature review. Journal of Clinical Nursing, 11 (4), 430–443.

Joungtrakul, J., Sheehan, B., & Aticomsuwan, S. (2013). Qualitative data collection tool: A new approach to developing an interview guide. AFBE Journal, 6 (2), 140–154.

Kemmis, S., & McTaggart, R. (1992) The Action Research Planner (3rd ed.). Geelong: Deakin University Press.

Kloppenburg, M., & Berenbaum, F. (2020). Osteoarthritis year in review 2019: Epidemiology and therapy. Osteoarthritis and Cartilage, 28 (3), 242–248.

Li, Z., Marshall, A. P., Lin, F., Ding, Y., & Chaboyer, W. (2022). Knowledge of pressure injury in medical and surgical nurses in a tertiary level hospital: A cross-sectional study. Journal of Tissue Viability, 31 (1), 24–29.

Lin, P.-C., Hung, S.-H., Wu, H.-F., Hsu, H.-C., Chu, C.-Y., & Su, S.-J. (2011). The effects of a care map for total knee replacement patients: Effectiveness of TKR care map. Journal of Clinical Nursing, 20 (21–22), 3119–3127.

Liu, C., Liu, R., Tang, M., Yang, X., & Gong, X. (2019). Role and mechanism of nursing cooperation and tetramethylpyrazine application in post‑operative pain in patients undergoing total knee arthroplasty. Experimental and Therapeutic Medicine.

Long, H., Liu, Q., Yin, H., Wang, K., Diao, N., Zhang, Y., Lin, J., & Guo, A. (2022). Prevalence Trends of Site‐Specific Osteoarthritis From 1990 to 2019: Findings from the Global Burden of Disease Study 2019. Arthritis & Rheumatology, 74 (7), 1172–1183.

Malley, A., Kenner, C., Kim, T., & Blakeney, B. (2015). The Role of the Nurse and the Preoperative Assessment in Patient Transitions. AORN Journal, 102 (2), 181.e1-181.e9.

Mandour, N., Shahin, E., & Abd El Reheem, H. (2022). Quality of Life for Patients After Total Knee Replacement Surgery. Port Said Scientific Journal of Nursing, 9 (1), 100–118.

Mantyh, P. W. (2014). The neurobiology of skeletal pain. European Journal of Neuroscience, 39 (3), 508–519.

Mora, J. C., Przkora, R., & Cruz-Almeida, Y. (2018). Knee osteoarthritis: Pathophysiology and current treatment modalities. Journal of Pain Research, Volume 11, 2189–2196.

Nakpalad, W., Koopantawee, N., & Sangchan, H. (2019). The Development and Evaluation of Clinical Nursing Practice Guideline for Promoting the Recovery of Older Patients with Total Knee Arthroplasty. Journal of The Police Nurses, 11(1), 73–85.

Pulkkinen, M., Junttila, K., & Lindwall, L. (2016). The perioperative dialogue—A model of caring for the patient undergoing a hip or a knee replacement surgery under spinal anaesthesia. Scandinavian Journal of Caring Sciences, 30 (1), 145–153.

Redondo-Sáenz, D., Cortés-Salas, C., & Parrales-Mora, M. (2023). Perioperative Nursing Role in Robotic Surgery: An Integrative Review. Journal of perianesthesia nursing: official journal of the American Society of PeriAnesthesia Nurses, S1089-9472 (22) 00594-9. Advance online publication.

Reyes III, R., Reyes, J. P., & Martinez, M. C. (2022). Work-Related Problems and Performance Level of Senior High School Teachers. LIFE: International Journal of Health and Life-Sciences, 8 (1), 01–22.

Reyes, J. (2019). Caring Theory in Correlation to Hospital Organizational Culture Towards A Sustainable Holistic Program for Nurses. LIFE: International Journal of Health and Life-Sciences, 5 (3), 21–40.

Rönn, K., Reischl, N., Gautier, E., & Jacobi, M. (2011). Current Surgical Treatment of Knee Osteoarthritis. Arthritis, 2011, 1–9.

Thomas, McColl, Cullum, Rousseau, & Soutter. (1999). Clinical guidelines in nursing, midwifery and the therapies: A systematic review. Journal of Advanced Nursing, 30 (1), 40–50.

Wehling, P., Moser, C., & Maixner, W. (2016). How does surgery compare with advanced intra-articular therapies in knee osteoarthritis: Current thoughts? Therapeutic Advances in Musculoskeletal Disease, 8 (3), 72–85.




How to Cite

Santisathaporn, R., & Chokpiriyawat, T. (2023). THE DEVELOPMENT OF NURSING CARE MODEL IN PATIENTS WITH TOTAL KNEE REPLACEMENT RECONSTRUCTIVE SURGERY: Received: 27th January 2023, Revised: 19th March 2023, 16th April 2023, Accepted: 21st April 2023. LIFE: International Journal of Health and Life-Sciences, 8, 44–60.